DRAFT PH Road Safety Implementation Guide
0.3.0 - ci-build Philippines flag

DRAFT PH Road Safety Implementation Guide, published by UP Manila - National Institutes of Health - National Telehealth Center. This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/UPM-NTHC/PH-RoadSafetyIG/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Structures: Logical Models

These define data models that represent the domain covered by this implementation guide in more business-friendly terms than the underlying FHIR resources.

RS Minimum Dataset (MDS) Logical Model

Abstract, sectioned logical model for the PH RS MDS covering incident, patient, encounter, clinical, vitals, injuries, evidence/documents, workflow, and finance. Elements mirror the CSV rows; mappings point to target FHIR elements for subsequent profiling.

Structures: Questionnaires

These define forms used by systems conforming to this implementation guide to capture or expose data to end users.

RS ONEISS Questionnaire

Structured Data Capture questionnaire for the DOH ONEISS Patient Injury form. Captures patient demographics, encounter information, clinical findings, incident context, injuries, and financial data mapped to RS profiles, supporting SDC $extract.

RS Run Report Questionnaire

Structured Data Capture questionnaire for the MMDA run report form. Captures workflow, incident, clinical, and vital sign data aligned with RS profiles so SDC $extract can populate Encounter, Observation, Location, Procedure, and ServiceRequest resources.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

RS AllergyIntolerance

Known allergies, substances and reactions.

RS Bundle — Minimum Data Set

Document Bundle for Minimum Data Set submission containing only the essential elements from Minimum-MS-1.csv. This bundle includes: Patient (demographics, identifiers), Encounter (type, timing, identifiers), Condition (initial impression, final diagnosis with ICD-10 codes), and key Observations (injury datetime, transport accident flag, mode of transport, outcome, disposition).

RS Claim

Claim information related to cost of care.

RS Condition

Condition resource for RS IG that supports multiple coding systems, textual entries and use-case specific semantics (initial impression, final diagnosis, medical history) via code.coding slicing and category usage.

RS Condition — External Cause (category)

Captures the ICD-10 external cause axis as a Condition.category slice. Use in addition to the specific diagnosis code.

RS Condition — Final Diagnosis

Final diagnosis per CSV mapping.

RS Condition — Initial Impression

Enter the initial impression on the patient’s condition.

RS Condition — Nature of Injury (category)

Captures the ICD-10 nature-of-injury axis as a Condition.category slice. Use in addition to the specific diagnosis code.

RS Condition — Problem

Problem (finding) per CSV mapping.

RS DocumentReference (Evidence)

Evidence and post-crash documentation linked to the incident (e.g., cause of crash, party at fault, incident management logs, CCTV, shape files).

RS Encounter

Encounter for EMS run report / facility submission context. Captures incident number, type, timing, participants, disposition & transfer.

RS HealthcareService

Healthcare services offered by organizations (e.g., EMS base, receiving facility clinics/units).

RS Incident Location

Location of incident; supports PH-Core address extensions and geolocation.

RS MedicationStatement

Current medications as codeable concepts or references where available.

RS Observation

Generic base Observation for RS data; specialized concept profiles below constrain code/value patterns.

RS Observation - Abrasion

Abrasion present; with optional site and details.

RS Observation - Activity at Time of Incident

Activity of the patient at time of incident; allow text fallback.

RS Observation - Avulsion

Avulsion present; with optional site and details.

RS Observation - Blood Alcohol Concentration

Blood alcohol concentration.

RS Observation - Blood Pressure

Blood pressure using component entries for systolic/diastolic.

RS Observation - Body Temperature

Body temperature.

RS Observation - CCTV Available

Availability of CCTV video.

RS Observation - Call Source

Call source description (free text).

RS Observation - Clinical Remarks

Clinical remarks/notes.

RS Observation - Collision Type

Collision type (Angle, Head-on, Rear end, Side swipe, etc.).

RS Observation - Collision vs Non-Collision

Indicates whether the incident was collision or non-collision.

RS Observation - Concussion

Concussion present; with site and details.

RS Observation - Condition of Patient

Overall condition of patient at assessment.

RS Observation - Contusion

Contusion present; with site and details.

RS Observation - Cyanosis

Cyanosis assessment.

RS Observation - Date/Time of Injury

DateTimestamp patient was seen at the health facility.

RS Observation - External Cause: Bites/Stings

Flag indicating bites/stings.

RS Observation - External Cause: Burns

Flag indicating burns as external cause.

RS Observation - External Cause: Burns

Flag indicating burns as external cause.

RS Observation - External Cause: Chemical/Substance

Observation for chemical/substance exposure.

RS Observation - External Cause: Contact with Sharp Object

Flag indicating sharp object cause.

RS Observation - External Cause: Drowning

Flag indicating drowning.

RS Observation - External Cause: Exposure to Forces of Nature

Flag indicating exposure to natural disaster/calamity.

RS Observation - External Cause: Fall

Flag indicating fall.

RS Observation - External Cause: Firecracker

Flag indicating firecracker-related cause.

RS Observation - External Cause: Gunshot

Flag indicating gunshot.

RS Observation - External Cause: Hanging/Strangulation

Flag indicating hanging/strangulation.

RS Observation - External Cause: Mauling/Assault

Flag indicating assault.

RS Observation - External Cause: Other

Flag indicating other external cause.

RS Observation - External Cause: Sexual Assault/Abuse/Rape (Alleged)

Flag indicating sexual assault.

RS Observation - Fracture

Fracture observation. Use valueCodeableConcept to indicate fracture type (e.g., open or closed). Sites captured in top-level bodySite and details in note.

RS Observation - Glasgow Coma Scale

GCS with components for eyes, verbal, motor; optional total score as integer.

RS Observation - How Many Vehicles Involved

Count of vehicles involved.

RS Observation - Injury Intent

Intent of injury (Unintentional, Intentional-self, Intentional-violence, Undetermined).

RS Observation - Level of Consciousness (AVPU)

Level of consciousness (e.g., AVPU).

RS Observation - Mode of Transport to Facility

Mode of transport to the hospital/facility; allow coded value with optional text for 'Others'.

RS Observation - Multiple Injuries?

Boolean flag indicating multiple injuries.

RS Observation - Open Wound

Open wound present; with site and details. Capture mechanism/type in a structured component (valueCodeableConcept with text).

RS Observation - Other Risk Factors

Other risk factors at the time of incident; allow text for 'Others'.

RS Observation - Other Specified Injury

Other specified injury present; capture type as valueCodeableConcept (text allowed) with optional site and details.

RS Observation - Other Vehicle/Object Involved

Other vehicle/object type involved; text for 'Others'.

RS Observation - Outcome at Release

Outcome at release from ER/OPD/RHU.

RS Observation - Patient's Vehicle

Type of vehicle used by patient; text for 'Others'.

RS Observation - Place of Occurrence

Place type where injury occurred; name can be carried in note when applicable.

RS Observation - Position of Patient

Seat/position (driver/front passenger/rear/pedestrian); text for 'Others'.

RS Observation - Presence of Traffic Investigator

Boolean presence/absence of traffic investigator.

RS Observation - Priority Level (Urgency)

System-generated urgency level per CAD/agency rules.

RS Observation - Pulse Rate

Pulse/heart rate in beats/min.

RS Observation - Pupils

Pupil size/reactivity summary.

RS Observation - Referred By Facility

Flag indicating patient was referred by another hospital/facility.

RS Observation - Reported Complaint

Free-text reported complaint. May or May not exactly be medical, could point to car crash, not a healthcare concern.

RS Observation - Respiratory Rate

Respiratory rate in breaths/min.

RS Observation - Run Report Comments

Enter other comment (s) regarding the case

RS Observation - Safety Accessories

Safety accessories present/used; allow text for 'Others'.

RS Observation - Status on Arrival

Status upon reaching facility/hospital.

RS Observation - Timeline Date Received

Date/time call received by dispatch for the incident.

RS Observation - Timeline Date/Time

Dispatch and transport timeline events capturing a precise date/time.

RS Observation - Timeline Time Departed

Time unit/personnel departed scene.

RS Observation - Timeline Time Enroute

Time unit/personnel went enroute to scene.

RS Observation - Timeline Time Hospital Arrival

Time patient arrived at hospital/facility.

RS Observation - Timeline Time On Scene

Time unit/personnel arrived on scene.

RS Observation - Timeline Time Station Arrival

Time unit/personnel arrived back at station.

RS Observation - Transferred From Facility

Flag indicating patient transferred from another hospital/facility.

RS Observation - Transport/Vehicular Accident

Boolean flag indicating transport/vehicular accident.

RS Observation - Traumatic Amputation

Traumatic amputation present; with site and details.

RS Observation - Triage Priority

Triage category assigned at scene (e.g., Red/Yellow/Green/Black).

RS Organization

Organization profile for EMS providers and receiving facilities involved in RS encounters.

RS Patient

Patient demographics and identifiers for RS reporting; reuse PH-Core address extensions for barangay/city/province/region.

RS Procedure

Procedures related to incident/report (e.g., coordination with receiving hospital, psychosocial support, interventions).

RS Procedure - Transport Coordination

Procedure record indicating whether transport coordination with the receiving hospital was done.

RS Service Location

Facility/service delivery location. Type bound to HL7 v3 ServiceDeliveryLocationRoleType (e.g., ER, ward, clinic).

RS ServiceRequest

Requests or records related to refusal to admit and related workflow signals.

RS Task

Workflow tracking for report receipt, durations of delay, and sources of delays.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

RS Encounter Vehicle Used

Identifier and type of transport vehicle used during an encounter.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

RS VS - PSGC Barangay

PSGC Barangay codes (managed externally).

RS VS - PSGC City/Municipality

PSGC City/Municipality codes (managed externally).

RS VS - PSGC Province

PSGC Province codes (managed externally).

RS VS - PSGC Region

PSGC Region codes (managed externally).

SILPH - Activity (VS)

SILPH Value Set for Patient Activity at the Time of Injury/Accident

SILPH - Burns (VS)

SILPH Value Set for Degree of Burn

SILPH - Cyanosis (VS)

SILPH Value Set for Presence of Cyanosis

SILPH - Element Terminology (VS)

SILPH Value Set for Element Terminology

SILPH - Encounter Participant Role (VS)

SILPH Value Set for EMS encounter participant roles documented on the run report.

SILPH - External Cause of Burns (VS)

SILPH Value Set for External Cause of Burns

SILPH - External Cause of Drowning (VS)

SILPH Value Set for External Cause of Drowning

SILPH - Fracture Type (VS)

SILPH Value Set for fracture type designation (open versus closed)

SILPH - GCS - Eyes (VS)

SILPH Value Set for GCS Eye Score

SILPH - GCS - Motor (VS)

SILPH Value Set for GCS Motor Score

SILPH - GCS - Verbal (VS)

SILPH Value Set for GCS Verbal Score

SILPH - General Disposition (VS)

SILPH Value Set for Inpatient and ER/Outpatient Visit Disposition

SILPH - ICD10 External Cause of Injury (VS)

SILPH Value Set for ICD 10 Codes for External Cause of Injury (Selected Codes from Chapter XX - V01-Y36, Y85-Y87, and Y89)

SILPH - ICD10 Nature of Injury (VS)

SILPH Value Set for ICD 10 Codes for Nature of Injury (Chapter XIX - S00-T98)

SILPH - Injury Intent (VS)

SILPH Value Set for Injury Intent

SILPH - Inpatient Disposition (VS)

SILPH Value Set for Inpatient Visit Disposition

SILPH - Level of Consciousness (VS)

SILPH Value Set for Level of Consciousness (AVPU) Score

SILPH - List of Body Sites (VS)

SILPH List of Body Sites

SILPH - Local Codes (VS)

SILPH Value Set for containing all Road Safety Local Codes (data element terminology codes and codes for value sets)

SILPH - Mode of Transport (VS)

SILPH Value Set for Mode of Transport of Patient to Healthcare Facility

SILPH - Other Vehicle in Collision (VS)

SILPH Value Set for Other Vehicle in Collision Accident

SILPH - Outcome (VS)

SILPH Value Set for Outcome

SILPH - Outpatient/ER Disposition (VS)

SILPH Value Set for Outpatient/ER Visit Disposition

SILPH - PR - Quality (VS)

SILPH Value Set for Pulse Quality

SILPH - PR - Rhythm (VS)

SILPH Value Set for Pulse Rhythm

SILPH - Patient's Vehicle (VS)

SILPH Value Set for Patient's Vehicle

SILPH - Place of Occurrence (VS)

SILPH Value Set for Place of Occurrence of Injury/Accident

SILPH - Position of Patient (VS)

SILPH Value Set for Position of Patient

SILPH - Pupils (VS)

SILPH Value Set for Pupil Reaction

SILPH - RR - Breath Sounds (VS)

SILPH Value Set for Breath Sounds

SILPH - RR - Rhythm (VS)

SILPH Value Set for Respiratory Rhythm

SILPH - Risk Factors (VS)

SILPH Value Set for Risk Factors

SILPH - Safety Devices (VS)

SILPH Value Set for Safety Devices

SILPH - Sex (VS)

SILPH Value Set for Sex

SILPH - Status (VS)

SILPH ValueSet for Patient Status, if Alive or Dead during Admission

SILPH - Status if Alive (VS)

SILPH Value Set for Patient Status, if patient is alive, specify if conscious or unconscious

SILPH - Transport Accident Type (VS)

SILPH Value Set for Transport Accident Type (Land, Water or Air)

SILPH - Transport Accident: Collision or Noncollision (VS)

SILPH Value Set for Transport Accident if Collision or Noncollision

SILPH - Triage (VS)

SILPH Value Set for Triage at Scene

SILPH - Type of Patient (VS)

SILPH Value Set for Type of Patient Encounter

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

SILPH Road Safety Local Codes

Compilation of local codes for SILPH Road Safety Project. Includes local codes for data element terminology mapping and local codes for value sets

Terminology: Concept Maps

These define transformations to convert between codes by systems conforming with this implementation guide.

MDSRoadSafety Logical Model to FHIR Mapping

Maps elements from the logical model to FHIR R4 resources. Generated by scripts/generate-conceptmap.js

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Example EMS Team Leader

Response team leader overseeing transport in rs-example-encounter.

Example Incident Location

Road traffic collision site at EDSA and Ayala Avenue used in rs-example-encounter.

Example PH Core Organization

An example instance of a PH Core Organization conforming to the Philippine localization profile.

Example RS Allergy

Peanut allergy record for rs-example-patient with active clinical status and unconfirmed verification.

Example RS Claim

Claim for rs-example-patient with PHP 1500 reimbursement submitted by rs-organization-single-ex.

Example RS Coverage

Coverage held by rs-example-patient with rs-organization-single-ex as payor for 2025 policy year.

Example RS DocumentReference

Crash scene photograph for rs-example-patient captured during rs-example-encounter.

Example RS ER Encounter

Emergency encounter for rs-example-patient documenting transport from incident scene to DOH Central ER on 2025-10-31.

Example RS HealthcareService

Emergency medical service offered by rs-organization-single-ex for rs-example-encounter support.

Example RS Incident Location

Collision site with barangay address and GPS coordinates for rs-example-encounter.

Example RS MedicationStatement

Active metformin therapy documented for rs-example-patient prior to the incident.

Example RS Observation - Abrasion

Abrasion details documented for rs-example-patient.

Example RS Observation - Activity at Incident

Activity at time of incident for rs-example-patient.

Example RS Observation - Avulsion

Avulsion injury captured for rs-example-patient.

Example RS Observation - Base

Generic observation captured during rs-example-encounter.

Example RS Observation - Blood Alcohol Concentration

Blood alcohol concentration measured for rs-example-patient.

Example RS Observation - Blood Pressure

Blood pressure measurement with systolic and diastolic components.

Example RS Observation - Body Temperature

Body temperature documented for rs-example-patient.

Example RS Observation - CCTV Available

CCTV availability captured for rs-example-encounter.

Example RS Observation - Call Source

Call source narrative captured for rs-example-encounter.

Example RS Observation - Clinical Remarks

Clinical remarks documented for rs-example-encounter.

Example RS Observation - Collision Type

Collision type recorded for rs-example-encounter.

Example RS Observation - Collision vs Non-Collision

Collision classification captured for rs-example-encounter.

Example RS Observation - Concussion

Concussion findings documented for rs-example-patient.

Example RS Observation - Condition of Patient

Overall patient condition captured during rs-example-encounter.

Example RS Observation - Contusion

Contusion details captured for rs-example-patient.

Example RS Observation - Cyanosis

Cyanosis assessment documented for rs-example-patient.

Example RS Observation - Date/Time of Injury

Date and time of injury logged for rs-example-patient.

Example RS Observation - External Cause: Bites/Stings

Bite/sting external cause flagged for rs-example-patient with specified animal agent.

Example RS Observation - External Cause: Burns

Burns external cause captured for rs-example-patient with fire agent specified.

Example RS Observation - External Cause: Chemical/Substance

Chemical exposure flagged for rs-example-patient with specific substance noted.

Example RS Observation - External Cause: Drowning

Drowning external cause recorded for rs-example-patient with body of water specified.

Example RS Observation - External Cause: Fall

Fall external cause flagged for rs-example-patient with specifics noted.

Example RS Observation - External Cause: Firecracker

Firecracker-related external cause identified for rs-example-patient.

Example RS Observation - External Cause: Forces of Nature

Exposure to forces of nature captured for rs-example-patient during the incident.

Example RS Observation - External Cause: Gunshot

Gunshot external cause flagged for rs-example-patient with weapon context provided.

Example RS Observation - External Cause: Hanging/Strangulation

Hanging/strangulation risk identified during rs-example-encounter.

Example RS Observation - External Cause: Mauling/Assault

Assault noted as contributing external cause for rs-example-patient.

Example RS Observation - External Cause: Other

Other external cause documented for rs-example-patient.

Example RS Observation - External Cause: Sexual Assault

Sexual assault recorded in rs-example-encounter context.

Example RS Observation - External Cause: Sharp Object

Sharp object injury flagged for rs-example-patient with object detail provided.

Example RS Observation - Fracture

Fracture classification recorded for rs-example-patient.

Example RS Observation - Glasgow Coma Scale

GCS subscores and total recorded for rs-example-patient.

Example RS Observation - How Many Vehicles

Count of vehicles involved in rs-example-encounter.

Example RS Observation - Injury Intent

Injury intent recorded as unintentional for rs-example-patient.

Example RS Observation - Level of Consciousness

AVPU assessment recorded as alert for rs-example-patient.

Example RS Observation - Mode of Transport

Mode of transport to facility documented for rs-example-patient.

Example RS Observation - Multiple Injuries

Multiple injuries flag recorded for rs-example-patient.

Example RS Observation - Nature of Burns

Burn severity captured for rs-example-patient.

Example RS Observation - Open Wound

Open wound details noted for rs-example-patient.

Example RS Observation - Other Injury

Other specified injury captured for rs-example-patient.

Example RS Observation - Other Risk Factors

Risk factors noted during rs-example-encounter.

Example RS Observation - Other Vehicle Involved

Other vehicle involved in collision recorded for rs-example-encounter.

Example RS Observation - Outcome

Outcome at release documented using SILPH Outcome value set.

Example RS Observation - Patient's Vehicle

Vehicle type used by rs-example-patient.

Example RS Observation - Place of Occurrence

Place of occurrence documented for rs-example-patient.

Example RS Observation - Position of Patient

Patient position in vehicle captured for rs-example-encounter.

Example RS Observation - Presence of Traffic Investigator

Traffic investigator presence noted for rs-example-encounter.

Example RS Observation - Priority Level

Computer-aided dispatch urgency captured for rs-example-encounter.

Example RS Observation - Pulse Rate

Pulse rate with rhythm and quality documented for rs-example-patient.

Example RS Observation - Pupils

Pupil assessment recorded as PEARL for rs-example-patient.

Example RS Observation - Referred By Facility

Referral from neighboring facility noted for rs-example-patient.

Example RS Observation - Reported Complaint

Reported complaint captured from caller for rs-example-patient.

Example RS Observation - Respiratory Rate

Respiratory rate with rhythm and breath sound components for rs-example-patient.

Example RS Observation - Run Report Comments

Free-text run report comments associated with rs-example-encounter.

Example RS Observation - Safety Accessories

Safety accessory usage recorded for rs-example-patient.

Example RS Observation - Status on Arrival

Patient status upon reaching facility documented for rs-example-encounter.

Example RS Observation - Timeline Date/Time

Transport timeline milestone recorded for rs-example-encounter.

Example RS Observation - Transferred From Facility

Patient transferred from another facility prior to rs-example-encounter.

Example RS Observation - Transport/Vehicular Accident

Transport accident flag asserted for rs-example-encounter.

Example RS Observation - Traumatic Amputation

Traumatic amputation documented for rs-example-patient.

Example RS Observation - Triage Priority

Triage priority assigned at scene for rs-example-patient.

Example RS Patient

Adult male patient referenced across RS examples with Manila home address and telecom details.

Example RS Procedure

Post-crash counselling documented for rs-example-patient during rs-example-encounter.

Example RS Procedure - Transport Coordination

Transport coordination with receiving hospital recorded for rs-example-encounter.

Example RS Service Location

Emergency room location for rs-organization-single-ex used in rs-example-encounter.

Example RS ServiceRequest

Refusal-to-admit notification raised for rs-example-patient during rs-example-encounter.

Example RS Task

Tracking refusal-to-admit follow-up for rs-example-patient including coordination timelines.

Example Receiving Facility Location

Emergency room location for Department of Health - Central Office receiving rs-example-encounter.

Example Receiving Practitioner

Practitioner who received rs-example-patient at the DOH Central ER.

Example Treatment Officer

EMS treatment officer providing care during rs-example-encounter.

Minimum Data Set Abrasion
Minimum Data Set Avulsion
Minimum Data Set BP
Minimum Data Set Bundle

Example bundle containing only the minimum required elements from Minimum-MS-1.csv.

Minimum Data Set CCTV Video
Minimum Data Set Collision Type
Minimum Data Set Concussion
Minimum Data Set Condition of Patient
Minimum Data Set Contusion
Minimum Data Set Current Medication
Minimum Data Set Disposition

Patient disposition for minimum data set.

Minimum Data Set Disposition Others Specify
Minimum Data Set Encounter

Encounter example with minimum required fields for Minimum Data Set.

Minimum Data Set External Cause (ICD-10)

ICD-10 External Cause code for minimum data set.

Minimum Data Set Final Diagnosis

Final diagnosis for minimum data set example.

Minimum Data Set Fracture
Minimum Data Set GCS
Minimum Data Set Incident Location

Incident at the corner of EDSA and Ayala Avenue

Minimum Data Set Initial Impression

Initial impression for minimum data set example.

Minimum Data Set Injury Date/Time

Date and time of injury for minimum data set.

Minimum Data Set Known Allergies
Minimum Data Set Mode of Transport

Mode of transport to hospital for minimum data set.

Minimum Data Set Mode of Transport Other
Minimum Data Set Multiple Injuries
Minimum Data Set Nature Burns
Minimum Data Set Nature of Injury (ICD-10)

ICD-10 Nature of Injury code for minimum data set.

Minimum Data Set Open Wound
Minimum Data Set Other Injury
Minimum Data Set Other Risk Factors
Minimum Data Set Other Vehicle Involved
Minimum Data Set Outcome

Patient outcome for minimum data set.

Minimum Data Set Patient

Patient example with minimum required demographics and identifiers for Minimum Data Set.

Minimum Data Set Patient's Vehicle
Minimum Data Set Position of Patient
Minimum Data Set Pulse
Minimum Data Set Reported Complaint
Minimum Data Set Reporting Health Facility
Minimum Data Set Respiratory Rate
Minimum Data Set Safety Accessories
Minimum Data Set Sources of Delays

Delay in transport due to heavy traffic

Minimum Data Set Temperature
Minimum Data Set Timeline Date Received
Minimum Data Set Timeline Time Departed
Minimum Data Set Timeline Time Enroute
Minimum Data Set Timeline Time Hospital Arrival
Minimum Data Set Timeline Time On Scene
Minimum Data Set Timeline Time Station Arrival
Minimum Data Set Transport Accident

Transport/vehicular accident flag for minimum data set.

Minimum Data Set Traumatic Amputation